Tumor markers limit imaging need in germ-cell tumor surveillance

By David Douglas

NEW YORK (Reuters Health) - 16/1/2019

Tumor markers are a sensitive, radiation-sparing means of surveillance in children and adolescents with malignant germ-cell tumors, according to a retrospective review.

As Dr. Adriana Fonseca told Reuters Health by email, "In general, children and adolescents with germ-cell tumors have very good outcomes with modern therapies. We strive to give them the best chance of survival while minimizing the risk of toxicity."

"It is important," she added, "to take into account not only the toxicity associated with chemotherapy, but also the cumulative radiation exposure from diagnostic scans. While rare, radiation can cause secondary malignancies. In addition, the parental anxiety and financial cost associated with these tests are not insignificant."

Dr. Fonseca of the The Hospital for Sick Children, in Toronto, and colleagues reviewed data on 284 patients with low-risk and intermediate-risk nongerminomatous malignant germ-cell tumors. The patients were followed for a median of 5.3 years

Only seven patients showed no tumor-marker elevation at diagnosis and none of this group went on to relapse, the researchers report in the Journal of Clinical Oncology, online December 21.

Forty-eight patients (16.9%) experienced a relapse a median of 134.5 days after enrollment. Of these, 47 were detected by tumor-marker elevation, most commonly alpha-fetoprotein.

Of the 49 patients who relapsed, 31 showed both abnormal tumor markers and imaging, 12 showed abnormal markers but imaging was unavailable, and four showed abnormal tumor markers but normal imaging. Marker levels were unknown in the one patient whose relapse was diagnosed by imaging alone.

Given the efficacy of tumor markers in detecting relapse, the researchers observe, "Eliminating exposure to imaging with ionizing radiation may enhance the safety of relapse surveillance."

Dr. Fonseca said, "we can significantly decrease the number of CT scans performed for surveillance in patients with markers for secreting tumors at diagnosis. With the results of this study we have changed the requirements for imaging in the current germ-cell tumor trials and we are hoping to incorporate this results into other practice guidelines."

SOURCE: https://bit.ly/2FAb4jT J Clin Oncol 2018.

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